Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis

IMPORTANCE: Burnout is prevalent in physicians and is known to negatively influence performance, career continuation, and patient care/safety. However, existing evidence does not offer clear recommendations for the management of burnout in physicians.
OBJECTIVE: To evaluate the effectiveness of interventions to reduce burnout in physicians. We also examined whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience) and healthcare setting characteristics (primary or secondary care) were associated with improved effects.
DATA SOURCES: Medline, Embase, PsycINFO, Cinahl, and Central, were searched from inception to May 2016. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.
STUDY SELECTION: Randomized controlled trials and controlled before-after studies of interventions targeting burnout in physicians.
DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of pre-specified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified using I2.
MAIN OUTCOME AND MEASURES: The core outcome was burnout scores focused on the emotional exhaustion domain, reported as standardized mean differences and their 95% Confidence intervals.
RESULTS: Nineteen independent comparisons from 18 studies (17 randomized controlled trials) were included in the meta-analysis (n=1,104 physicians). Interventions were associated with small significant reductions in burnout (SMD=-0.31, 95% CI=-0.45 to -0.16). Subgroup analyses suggested significantly improved treatment effects for organization-directed interventions (SMD= =-0.45, 95% CI=-0.62 to -0.28) compared to physician-directed interventions (SMD=-0.19, 95% CI=-0.36 to -0.01). Interventions targeting experienced physicians and primary care physicians were associated with higher effects, compared with interventions targeting inexperienced physicians or those working in secondary care, but these group differences were not statistically significant. The results were not influenced by the risk of bias ratings.
CONCLUSION: This systematic review and meta-analysis focused on the effects of controlled interventions on burnout in physicians. Evidence suggests that interventions directed at the healthcare organization may have more potential to reduce burnout in physicians. This finding provides support for the view that burnout is a problem of the whole healthcare organization, rather than individual physicians.